Hematological Ratios Associated With Acute raum Injury and Mortality in Patients that present With Suspected Infection at Lub Tuam Tsev Saib Xyuas Xwm Ceev
Aug 19, 2024
Ntsiab lus:hematological piv; chav haujlwm xwm txheej ceev;mob raum raug mob; kev tuag; kab mob; o
NEW HERBAL FORMULATION FOR KIDNEY DISEASE
1. Taw qhia
Mob raum mob (AKI)yog ib pawg ntawm cov tsos mob tshwm sim los ntawm kev poob qis ntawm lub raum ua haujlwm [1–3]. Covqhov xwm txheej ntawm AKINws txawv nyob ntawm seb cov pejxeem thiab cov ntsiab lus siv thiab tau nce tsis tu ncua nyob rau ob peb lub xyoo dhau los [3,4]. AKI feem ntau tshwm sim hauv cov neeg mob septic mob hnyav thiab cuam tshuam nrog ntau qhov tshwm sim luv luv thiab ntev, suav nrog kev nyob hauv tsev kho mob ntev dua, kev mob hnyav (piv txwv li, kev txhim kho ntawm cov kab mob hauv lub raum kawg nrog rau kev xav tau kev kho lub raum hloov ( RRT)), thiab kev tuag. Ua ke, qhov no ua rau muaj kev puas tsuaj ntawm kev ruaj ntseg ntawm kev kho mob [5–8].
AKI muaj ib tug complex pathophysiology thiab feem ntau txoj kev loj hlob yog multifactorial. Cov kab mob hnyav thiab mob sepsis hauv cov neeg mob hnyav ua rau ib feem tseem ceeb ntawm qhov ua rau AKI, thiab muaj cov pov thawj loj zuj zus tuaj tias txawm tias cov neeg mob uas tsis tshua muaj kab mob hnyav tuaj yeem muaj kev pheej hmoo ntau dua ntawm kev tsim AKI [9,10]. Kev mob tshwm sim tuaj yeem ua lub luag haujlwm tseem ceeb hauv pathogenesis ntawm AKI hauv cov neeg mob uas muaj kab mob hnyav lossis sepsis, thiab cov pov thawj qhia tau tias AKI tuaj yeem tshwm sim txawm tias tsis muaj hypoperfusion [11]. Txawm li cas los xij, kev lees paub ntxov thiab kev kho mob ntawm AKI tseem nyuaj. Yog li ntawd, nws yog ib qho tseem ceeb los soj ntsuam cov kev pheej hmoo rau AKI. Tam sim no, kev kuaj mob ntawm AKI feem ntau yog nyob ntawm kev siv cov ntshav creatinine (SCr), uas tuaj yeem ncua sijhawm thiab cuam tshuam los ntawm ntau yam [12].
Tseeb, ntau qhov kev tshawb fawb tau tsom mus rau biomarkers (piv txwv li, KIM-1, NGAL) txhawm rau txheeb xyuas AKI nyob rau theem pib [13]. Txawm li cas los xij, ib qho biomarkers tau raug pov thawj tias tsis muaj kev nkag siab txaus rau kev tshawb pom ntawm AKI thiab tsis muaj nyob rau hauv kev kho mob txhua hnub. Cov kev tshawb fawb tsis ntev los no tau piav qhia txog cov ntshav suav kom muaj feem cuam tshuam nrog AKI [13]. Ntau qhov sib piv hematological uas tuaj yeem suav los ntawm cov ntshav suav (CBC) yog txuam nrog kev mob [14–16]. Raws li kev mob hauv zos thiab cov kab mob hauv lub cev ua lub luag haujlwm tseem ceeb hauv kev pib thiab kev loj hlob ntawm AKI thiab kev tuag ntawm cov neeg mob uas muaj kab mob, cov kab mob hematological tuaj yeem cuam tshuam nrog AKI thiab kev tuag ntawm cov neeg mob. Yog li, txoj kev tshawb fawb no tau tsom mus rau kev tshawb fawb txog kev sib raug zoo ntawm cov kab mob hematological, uas tau muab los ntawm CBC niaj hnub, thiab qhov tshwm sim ntawm AKI thiab kev tuag hauv cov neeg mob uas xav tias muaj tus kab mob ntawm lub chaw kho mob xwm txheej ceev.
2. Cov ntaub ntawv thiab cov txheej txheem
2.1. Kawm Tsim
Txoj kev tshawb nrhiav kev soj ntsuam yav tom ntej no tau ua tiav ntawm University Medical Center Utrecht (UMCU). UMCU yog ib lub tsev kho mob loj, kev qhia ntawv qib siab nyob rau hauv Netherlands. Cov neeg mob uas tau piav qhia hauv txoj kev tshawb no tau suav nrog thaum lub Cuaj Hlis 13, 2016 thiab 1 Lub Ib Hlis 2019 thiab ua raws li lub sijhawm tuag lossis raug kaw vim tsis tau rov qab los lossis txog rau ib xyoos tom qab lawv qhov chaw saib xyuas xwm txheej ceev. Cov ntaub ntawv kho mob tau siv los ntawm SPACE cohort (SePsis hauv cov neeg mob hnyav hauv chav xwm txheej ceev) [17]. Txoj kev tshawb no tau tshuaj xyuas thiab pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm UMCU raws li tus lej 16/594 thiab tau sau npe hauv Dutch Trial Register (NTR) raws li tus lej 6916. Txij li tsuas yog cov ntaub ntawv pseudonymized suav nrog, pawg saib xyuas txiav txim siab tias sau ntawv tso cai rau tus neeg mob tsis yog. xav tau. Txoj kev tshawb no tau ua los ntawm Kev Tshaj Tawm ntawm Helsinki.
2.2. Kawm Pej Xeem thiab Kev Sau Cov Ntaub Ntawv
SPACE cohort muaj tag nrho cov neeg mob sib law liag uas ua tau raws li cov hauv qab no: (1) Ntau dua lossis sib npaug li 18 xyoo lossis tshaj saud; (2) kev nthuav qhia ntawm lub tuam tsev kho mob xwm txheej ceev uas xav tias muaj tus kab mob uas tau teev tseg los ntawm tus kws kho mob; (3) sau npe nyob rau hauv lub chaw kho mob xwm txheej ceev rau lub internal-medicine department los yog ib tug ntawm nws subspecialties ntawm oncology, rheumatology, immunology, hematology, nephrology, endocrinology, geriatrics, kis kab mob los yog vascular tshuaj [17]. Rau cov kev ntsuam xyuas tam sim no, cov neeg mob tau txais RRT, cov neeg mob uas tsis muaj cov hauv paus ntsiab lus lossis kev soj ntsuam xyuas SCr, thiab cov neeg mob uas tau rov mus saib xyuas qhov xwm txheej ceev hauv 30 hnub tsis suav nrog. Cov pej xeem, cov ntaub ntawv kho mob tau sau tseg thaum lub sijhawm nthuav tawm hauv chav haujlwm xwm txheej ceev thiab, yog tias muaj, thaum mus pw hauv tsev kho mob, nrog rau cov ntaub ntawv ntawm cov cim ntsuas, kev kho mob, thiab cov txiaj ntsig tau raug sau rau txhua tus neeg mob tsim nyog hauv pawg neeg no. Cov ntaub ntawv hais txog kev tiv thaiv kab mob, kev tsis sib haum xeeb, kev kuaj mob ntawm kev nkag mus, thiab kev kuaj mob thaum tso tawm tau raug muab rho tawm los ntawm Cov Ntaub Ntawv Kho Mob Hluav Taws Xob (EHR) los ntawm cov kws tshawb fawb ywj pheej thiab tshuaj xyuas siv cov txheej txheem ua ntej thiab cov txheej txheem txhais. Tag nrho cov ntaub ntawv muaj nyob ntawm SCr hauv 30 hnub tom qab kev nthuav qhia tau muab rho tawm los ntawm EHR. QSOFA cov qhab nia raug suav los ntawm kev muab ib qho taw qhia rau txhua qhov kev ua pa ntau dua lossis sib npaug ntawm 22 ua pa / min, systolic ntshav siab tsawg dua lossis sib npaug li 100 mm Hg, thiab hloov pauv lub hlwb) thiab tau txiav txim siab zoo nyob rau hauv cov ntaub ntawv ntawm tus qhab nia. Loj dua los yog sib npaug rau 2 [18]. Comorbidities tau suav nrog siv Charlson Comorbidity Index (CCI) [19].
Cov ntaub ntawv ntxiv tau muab rov qab siv Utrecht Patient-Oriented Database (UPOD). Cov qauv thiab cov ntsiab lus ntawm UPOD tau piav qhia ntau ntxiv nyob rau lwm qhov [20]. Cov cim hematological tau muab rov qab los ntawm UPOD uas tau txiav txim siab los ntawm kev kuaj ntshav-hlwb ua haujlwm nrog Abbot Cell-Dynn Sapphire hematology analyzer (Abbott Hematology, Santa Clara, CA, USA). Kev teeb tsa UPOD txuag ntau yam ntawm hematological tsis, txawm tias lawv tsis tau thov tshwj xeeb los ntawm tus kws kho mob [20].
2.3. Hematological Ratios
Los ntawm txhua tus neeg mob, cov qauv ntshav uas tau txais thaum lub sijhawm nthuav tawm hauv chav haujlwm xwm txheej ceev tau raug tshuaj xyuas los txiav txim siab cov ntshav suav tag nrho raws li ib feem ntawm kev kho mob niaj hnub. Tom qab ntawd cov hematological piv tau suav los ntawm cov txiaj ntsig. Kev hloov kho delta-neutrophil Performance index (hloov DNI) tuaj yeem txiav txim siab los ntawm kev rho tawm cov feem ntawm segmented neutrophils los ntawm cov lej ntawm cov feem ntawm tag nrho cov neutrophils thiab eosinophils. Qhov piv ntawm neutrophil-rau-lymphocyte (NLR) (neutrophil suav / lymphocyte suav) [14], monocyte-to-lymphocyte ratio (MLR) (monocyte suav / lymphocyte suav) [15], segmented-neutrophil-to-monocyte ratio ( SMR) (segmented neutrophil suav/monocyte suav), platelet-to-lymphocyte ratio (PLR) (platelet suav/lymphocyte suav) [16], neutrophil-rau-lymphocytes-thiab-platelets ratio (NLPR) ((neutrophil suav × 100) )/(lymph cytes suav × platelet suav)) [21] thiab systemic immune-inflammation (SII) index (platelet suav × (neutrophil suav / lymphocyte suav)) [22] tau suav tag nrho los ntawm cov ntshav suav tag nrho. Qhov hloov kho DNI thiab SMR tau tshwm sim los ntawm yav dhau los tau piav qhia delta-neutrophil index (DNI) thiab segmented-neutrophil-rau-mature-monocyte ratio (SeMo), feem [23,24]. Txawm li cas los xij, txij li txoj kev sib piv tsis tau siv los txiav txim siab txog kev loj hlob ntawm leukocyte, lwm cov npe tau raug xaiv los piav txog cov piv txwv no.
2.4. Cov txiaj ntsig thiab kev txhais
The primary outcome of this study was the development of AKI within 30 days after presentation at the emergency department. The diagnosis and staging of AKI were based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and were defined as an increase in SCr of 1.5 times the baseline value or an increase in SCr of 26.5 umol/L relative to the value measured at the emergency department within the first 48 h after presentation (stage 1) [2]. Baseline creatinine was defined as the most recent SCr measurement available from 7 days to 12 months before presentation at the emergency department. The median period between baseline SCr and presentation at the emergency department was 24 days (interquartile range [IQR] 13–56). The highest SCr within 30 days was used to stratify the KDIGO stages of AKI, with an increase of 2.0 to 2.9 times baseline SCr being classified as stage 2, and an increase of >3.
Qhov txiaj ntsig thib ob tau txhais tias yog kev tuag tag nrho tsis pub dhau 30 hnub tom qab kev nthuav qhia lub tuam tsev xwm txheej kub ntxhov. Kev soj ntsuam rhiab heev rau AKI thiab tag nrho-ua rau kev tuag nyob rau hauv 14 hnub tom qab qhov kev nthuav qhia thaum muaj xwm txheej ceev tau suav nrog los ntsuas qhov ua tau zoo ntawm cov txiaj ntsig.
2.5. Kev Tshawb Fawb Txog Kev Tshawb Fawb
(ARBs), diuretics, proton-pump inhibitors (PPIs), thiab non-steroidal anti-inflammatory tshuaj (NSAIDs), kab mob hnyav (qSOFA), thiab kev kuaj mob ib ntus hauv chav kho mob xwm txheej ceev. Kev soj ntsuam rhiab heev tau ua tiav siv tib yam Cox cov qauv kev phom sij nrog rau lub sijhawm sib txawv rau qhov tshwm sim. Qhov tseem ceeb ntawm kev txheeb cais tau txhais ntawm p-tus nqi<0.05. Statistical analyses were performed with the statistical software package SPSS 25.0 for Windows (IBM Corp, Armonk, NY, USA).
3. Cov txiaj ntsig
3.1. Kawm cov pej xeem thiab cov yam ntxwv hauv paus
Los ntawm 3,669 tus neeg mob, tag nrho ntawm 1,889 tus neeg mob tseem tsim nyog rau qhov kev ntsuam xyuas zaum kawg (Daim duab 1). Cov yam ntxwv tseem ceeb ntawm cov neeg mob suav nrog yog qhia hauv Table 1. Cov hnub nyoog nruab nrab yog 62 xyoo (IQR 50-70) thiab 54.5% ntawm cov neeg mob yog txiv neej. Cov kab mob ua pa qis (22.0%) yog qhov kev kuaj mob ntau tshaj plaws nyob rau hauv lub chaw kho mob xwm txheej ceev, tom qab ntawd los ntawm cov kab mob urinary (17.7%) thiab kab mob ua pa (15.5%). Ntawm tag nrho cov neeg mob, 821 (43.3%) tau immunocompromised thiab 98 (5.2%) raug suav hais tias mob hnyav raws li qSOFA tus qhab nia siab dua lossis sib npaug rau 2.
Daim duab 1. Flowchart of study attrition. Cov ntawv luv: AKI, mob raum raug mob; ED, chav haujlwm xwm txheej ceev; RRT, kho lub raum hloov; SCr, ntshav creatinine.
3.2. Qhov xwm txheej ntawm AKI
Hauv pawg AKI, muaj 123 (76.9%) cov neeg mob AKI theem 1, 20 (12.5%) cov neeg mob AKI theem 2, thiab 17 (10.6%) cov neeg mob AKI theem 3.
3.3. Hematological Ratios hauv AKI thiab Tsis-AKI Cov Neeg Mob
Cov hematological ratios xam los ntawm CBC thiab kev faib nruab nrab ntawm AKI thiab cov neeg mob uas tsis yog-AKI tau pom nyob rau hauv Table 2. NLR ( nruab nrab AKI pab pawg 8.52, IQR 4.38–17.92 vs. nruab nrab non-AKI pawg 6.80, IQR 3.17–12.73). , SMR (median AKI pab pawg 10.97, IQR 7.03–17.10 vs. qhov nruab nrab tsis-AKI pawg 8.83, IQR 5.62–13.88) thiab NLPR ( nruab nrab AKI pawg 4.84, IQR 2.01–10.13 vs. 45 pawg tsis-AKI IQR, 6.55) tau ntau dua hauv pawg AKI piv rau pawg tsis yog AKI. Tsis tas li ntawd, qhov kev faib tawm ntawm peb qhov piv txwv no txawv ntawm ntau theem ntawm AKI (Cov Duab Ntxiv S1).
Cov ntawv luv: ACE, angiotensin-hloov enzyme; AKI, mob raum raug mob; CKD-EPI, Kev sib koom tes ntawm Kab Mob Raum Kab Mob Sib Kis; ED, chav haujlwm xwm txheej ceev; eGFR, kwv yees glomerular pom tus nqi; IQR, interquartile ntau; NSAID, non-steroidal tshuaj tiv thaiv kab mob; qSOFA, Kev ntsuam xyuas ceev Sepsis-Related OrganFailure Assessment.
Table 3 qhia txog qhov txaus ntshai piv rau ntau qhov sib piv hematological thiab qhov tshwm sim ntawm AKI<30 days after the emergency department visit. In the univariate Cox regression, there was a significant association between AKI and the highest tertiles of the NLR, SMR, NLPR, and SII index. After adjustment for age, sex, comorbidities, baseline renal function, immune status, medication use, disease severity, and diagnosis in the emergency department, the highest tertile of the NLR (adjusted HR 1.8, 95% confidence interval [95% CI] 1.2–2.8), middle tertile of the SMR (adjusted HR 1.7; 95% CI 1.1–2.6), highest tertile of the SMR (adjusted HR 2.0; 95% CI 1.3–3.0) and highest tertile of the NLPR (adjusted HR 2.1; 95% CI 1.4–3.2) remained independently associated with the occurrence of AKI <30 days after emergency-department presentation. In a continuous analysis, NLR and SMR were significant as well (adjusted HR 1.002; 95% CI 1.001–1.002 and adjusted HR 1.005; 95% CI 1.003–1.008, respectively).
Cov ntawv luv: HR, kev phom sij; AKI, mob raum raug mob; DNI, delta-neutrophil index; NLR, neutrophil rau-lymphocyte ratio; MLR, monocyte-rau-lymphocyte piv; SMR, segmented-neutrophil-rau-monocyte piv; PLR, platelet-rau-lymphocyte piv; NLPR, neutrophil-rau-lymphocyte-platelet ratio; SII index, systemic immuneitis index. Cov lej loj qhia txog qhov tseem ceeb. Kev Kho kom haum rau hnub nyoog, thiab poj niam txiv neej. b Kev kho ua rau lub hnub nyoog, poj niam txiv neej, cov qhab nia comorbidity, lub raum ua haujlwm hauv lub raum, kev tiv thaiv kab mob. c Kev kho ua rau hnub nyoog, poj niam los txiv neej, cov qhab nia comorbidity, lub raum ua haujlwm hauv lub raum, kev tiv thaiv kab mob, kev siv tshuaj. d Kev kho kom haum rau hnub nyoog, poj niam txiv neej, cov qhab nia sib txawv, lub raum ua haujlwm hauv lub raum, kev tiv thaiv kab mob, kev siv tshuaj, kev mob hnyav, thiab kev kuaj mob ib ntus hauv chav kho mob xwm txheej ceev.
3.5. Kev sib koom ntawm Hematological Ratios thiab Mortality
Ntawm 1889 tus neeg mob, 102 tuag hauv 30 hnub (5.4%). Kev tsom xam ntawm Cox cov qauv kev phom sij tau pom tau tias muaj kev sib koom ua ke ntawm ob peb hematological ratios thiab 30-hnub tuag (Table 4). Tom qab hloov kho rau confounders, qhov siab tshaj plaws tertile ntawm NLR (Kho HR 1.7; 95% CI 1.0–2.9), siab tshaj plaws tertile ntawm SMR (hloov HR 1.8; 95% CI 1.1–3.1), siab tshaj tertile ntawm PLR (hloov HR 1.7; 95% CI 1.1–2.8), nruab nrab thiab siab tshaj plaws tertiles ntawm NLPR (hloov HR 2.5; 95% CI 1.4–4.4 thiab kho HR 2.1; 95% CI 1.2–3.7), thiab siab tshaj tertile ntawm SIIed index (adjust HR 1.8; 95% CI 1.1–2.8) tau pom tias nws tus kheej cuam tshuam nrog 30-hnub kev tuag raws li piv nrog cov tertiles qis tshaj. Hauv kev soj ntsuam tas li, NLPR tau cuam tshuam nrog 30-hnub tuag (hloov HR 1.008; 95% CI 1.003–1.013).
Cov ntawv luv: HR, kev phom sij; AKI, mob raum raug mob; DNI, delta-neutrophil index; NLR, neutrophilto-lymphocyte ratio; MLR, monocyte-rau-lymphocyte piv; SMR, segmented-neutrophil-rau-monocyte piv; PLR, platelet-rau-lymphocyte piv; NLPR, neutrophil-rau-lymphocyte-platelet ratio; SII index, systemic immune\inflammation index. Cov lej loj qhia txog qhov tseem ceeb. Kev kho ua rau hnub nyoog, poj niam txiv neej. b Kev kho ua rau lub hnub nyoog, poj niam txiv neej, cov qhab nia comorbidity, lub raum ua haujlwm hauv lub raum, kev tiv thaiv kab mob. c Kev kho ua rau hnub nyoog, poj niam los txiv neej, cov qhab nia comorbidity, lub raum ua haujlwm hauv lub raum, kev tiv thaiv kab mob, kev siv tshuaj. d Kev kho kom haum rau hnub nyoog, poj niam txiv neej, cov qhab nia sib txawv, lub raum ua haujlwm hauv lub raum, kev tiv thaiv kab mob, kev siv tshuaj, kev mob hnyav, thiab kev kuaj mob ib ntus hauv chav kho mob xwm txheej ceev.
